MEDICARE: LISA CARTER GREENE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC006415	GA

General Provider Information

NPI Number	:	1366709420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA CARTER GREENE LPC

Provider Business Mailing Address
First Line	:	106 BROWNING PT
Second Line	:
City	:	BYRON
State	:	GA
Zip	:	31008-9534
Country	:	US
Telephone Number	:	478-714-9318
Fax Number	:	478-333-6531

Provider Business Practice Location Address
First Line	:	106 BROWNING PT
Second Line	:
City	:	BYRON
State	:	GA
Zip	:	31008-9534
Country	:	US
Telephone Number	:	478-714-9318
Fax Number	:	478-475-9492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	05/06/2019

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Directions to “ LISA CARTER GREENE LPC” Practice Location

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